Provider Demographics
NPI:1366616922
Name:PROACTIVE CARE CHIROPRACTIC
Entity type:Organization
Organization Name:PROACTIVE CARE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:SEALE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-254-0616
Mailing Address - Street 1:808 SE CHKALOV DR.
Mailing Address - Street 2:SUITE 1
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683
Mailing Address - Country:US
Mailing Address - Phone:360-254-0616
Mailing Address - Fax:360-254-0618
Practice Address - Street 1:808 SE CHKALOV DR.
Practice Address - Street 2:SUITE 1
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:86383
Practice Address - Country:US
Practice Address - Phone:360-254-0616
Practice Address - Fax:360-254-0618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034699261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service